Dr. Patricia Parker, a clinical psychology graduate from the San Diego State University/University of California San Diego Joint Doctoral Program is currently an Instructor at The University of Texas M.D. Anderson Cancer Center. Dr. Parker has a strong background in psychosocial adjustment to illness with a specific emphasis on quality of life issues with cancer patients and physician-patient communication. Dr. Parker has proposed a combination of education, mentoring, and research to build on her current skills and develop additional expertise in the areas of psycho-oncology and physician-patient communication. The educational plan includes a series of formal coursework and seminars (e.g., cancer prevention, longitudinal data analysis), and the mentoring support of expert faculty from M.D. Anderson, Johns Hopkins University, and The Ohio State University. The proposed research plan has 3 primary aims: 1) to assess whether illness uncertainty is associated with psychological distress and QOL in patients who present with metastatic tumors of unknown primary, 2) to examine the relationship between physician-patient communication and psychological adjustment and QOL and to assess the relationship between illness uncertainty and physician-patient communication, and 3) to examine two possible moderators of the illness uncertainty and QOL relationship and the physician-patient communication and QOL relationship--social support and sense of coherence. Patients will be recruited at their initial visit to M.D. Anderson and the consultation meetings between participants and their physicians will be audiotaped. Patients will complete assessments of illness uncertainty, satisfaction with physician-patient communication, social support, sense of coherence, mood, and QOL following the consultation sessions, just prior to the initiation of treatment, and 1 and 6 months later. The proposed research will add to the information known about the role of uncertainty in illness and the influence of physician-communication on patients' psychological adjustment and QOL. Results from the proposed study have important implications for developing future interventions to improve cancer patients' QOL. The proposed K07 Research Award would allow Dr. Parker to transition into an independent researcher in cancer prevention with a focus on psycho-oncology and physician-patient communication.